Celiacs on a Gluten-Free Diet Three Times More Likely to Suffer from Non-Alcoholic Liver Disease
A gluten-free diet (GFD) is known to be associated with altered macronutrient intake and metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) is the hepatic hallmark of metabolic syndrome. The risk of NAFLD in patients with coeliac disease (CD) adhering to a GFD remains to be fully investigated; in particular, data from real-life clinical settings are lacking.
- F. Tovoli; G. Negrini; R. Farì; E. Guidetti; C. Faggiano; L. Napoli; L. Bolondi; A. Granito, Medscape 1
Study Aim: To assess the prevalence and relative risk of NAFLD in CD patients treated with a GFD.
Methods: Case-control study, with prospective enrolment of CD outpatients following a GFD and controls. Patients were matched for demographic characteristics (age and gender) and metabolic risk factors (overweight, diabetes mellitus, total cholesterol, and triglycerides) using a 1:1 ratio. NAFLD was diagnosed according to the European Association for the Study of the Liver criteria.
Results: 202 CD patients and 202 controls were compared. The raw prevalence of NAFLD was 34.7% and 21.8% in the CD and control group, respectively (P = 0.006). Binary logistic regression confirmed an increased risk of NAFLD in the CD group (adjusted odds ratio = 2.90, 95% confidence interval: 1.64–5.15, P < 0.001). Additionally, the relative risk for NAFLD was notably higher in non-overweight CD patients (adjusted odds ratio = 5.71, 95% confidence interval: 2.30–14.19, P < 0.001).
Discussion: We describe the first controlled study specifically designed to assess the risk of NAFLD in a real-life population of CD outpatients on a GFD. The most important results were:
- a threefold risk of NAFLD in CD patients in contrast with a control population matched for age, gender and metabolic risk factors;
- an even higher relative risk of NAFLD in the lean population;
- a comparative view of the characteristics of the CD with NAFLD (CD-NAFLD) population compared to the CD-only population.
- a significant proportion of CD patients adhering to a GFD developed a metabolic syndrome as early as 1 year after the GFD was initiated
- the relative risk of NAFLD was notably higher in nonoverweight CD patients – a difference that accounted for a sixfold increase in risk
- altered intestinal permeability and small intestinal bowel overgrowth are common in patients with celiac disease. These pathogenic mechanisms have also been described in NAFLD suggesting a possible pathogenic link
- a high rate of development of metabolic syndrome was observed following the first year of a GFD
Conclusions: More than one-third of CD patients adhering to a GFD had concurrent NAFLD, accounting for a three-fold increased risk compared to the general population. Further studies are needed to clarify if this risk is attributable to the GFD alone or to persistent gut-liver axis alterations. Dietary advice provided using a patient-tailored approach should assist CD patients with NAFLD in achieving an appropriate nutritional intake whilst reducing the risk of long-term liver-related events.